Prior Authorization Codes Updated for Commercial Members, Effective July 1, also watch for Medical Oncology Portal Enhancements

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements that may apply to some commercial members, to reflect new, replaced or removed codes.  These changes are based on updates from utilization management prior authorization assessment, including Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System (HCPCS) code changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.

Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Changes include:

  • July 1, 2023 – Addition of Medical Oncology codes to be reviewed by Carelon Medical Benefits Management (Carelon) formerly AIM Specialty Health
  • July 1, 2023 – Addition of Genetic Testing codes to be reviewed by Carelon
  • July 1, 2023 – Addition of Advanced Imaging codes to be reviewed by Carelon
  • July 1, 2023 – Replacement of an Infusion Site of Care drug code to be reviewed by BCBSMT
  • July 1, 2023 – Replacement of an Orthopedic Musculoskeletal code to be reviewed by BCBSMT

More Information: For a revised list of codes go to the Predetermination and Preauthorization section of our provider website.

Also, effective May 14, 2023, enhancements to Carelon’s ProviderPortal will create an easier intake process for its Medical Oncology program. Register for a free training from Carelon below:

Note: Effective April 1, 2023, the prior authorization list will include a link to the medical policy website for review of the specific medical policies associated with the procedure code rather than listing the medical policy number and title for each code. The list will continue to include information on whether prior authorization for the procedure code is managed by BCBSMT or by Carelon

CPT copyright 2022 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

Carelon Medical Benefits Management (Carelon) is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.